Post-stroke lower urinary system dysfunction and its relation with functional and mental status: a multicenter cross-sectional study

Incidence and influencing factors of urinary incontinence in stroke patients: A meta-analysis

BACKGROUND

The incidence of stroke in China ranks first in the world and is the leading cause of death and disability in adults. Urinary incontinence is an independent risk factor leading to poor prognosis of stroke. However, studies on the incidence of urinary incontinence in stroke patients and its influencing factors are different, fluctuate greatly, and there is no unified basis.

OBJECTIVE

To quantitatively analyze the incidence of urinary incontinence in stroke patients and its related influencing factors, and further make public health strategic decisions to reduce the occurrence of adverse outcomes.

METHODS

Computer searches were conducted in PubMed, Medline, Web of Science, Cochrane Library, Embase, CLNAHL Complete, China National Knowledge Infrastructure (CNKI), Chinese Biomedical database(CBM), Wan Fang Database, VIP Database, observational studies such as cohort studies, case-control studies or cross-sectional studies on the incidence or influencing factors of urinary incontinence in stroke patients from the establishment of the database to the publication in August 2023. Studies selection, quality evaluation and data extraction were conducted independently by two researchers according to the established search strategy. Stata 14.0 statistical software was used for meta-analysis.

RESULTS

A total of 21 manuscripts were included, with a cumulative sample size of 7327 cases, including 2887 patients with urinary incontinence. Meta-analysis results showed that the incidence of urinary incontinence in stroke patients was 38% [95% confidence interval (34%, 41%)], including married patients and lacunar infarction were the protective factors for urinary incontinence in stroke patients, while age, chaperone, low educational level, chronic cough, lesion sites (parietal lobe, frontal lobe, and temporal lobe), stroke type (cerebral hemorrhage, subarachnoid hemorrhage and cerebral hemorrhage complicated with subarachnoid hemorrhage), dysfunction (aphasia dyslexia, dysphagia, eye movement abnormalities, leg muscle disorders), post-stroke depression, the higher the NIHSS score, the lower the Bachmann index (BI) score, OCSP classification (total anterior circulation infarction) and other 11 items were risk factors for urinary incontinence in stroke patients.

CONCLUSION

The incidence of urinary incontinence in stroke patients is 38%. Marriage and lacunar infarction are the protective factors of urinary incontinence. Age, carer, low educational level, chronic cough, lesion site (parietal, frontal and temporal lobes), stroke type (cerebral hemorrhage, subarachnoid hemorrhage, cerebral hemorrhage combined with subarachnoid hemorrhage), dysfunction (aphasia and dysarthria syndrome, dysphagia, eye movement abnormalities, leg muscle disorders), post-stroke depression, and higher NIHSS score, Lower BI score and OCSP classification (total anterior circulation infarction) were risk factors for urinary incontinence in stroke patients.

Correlation between ischemic stroke topography and female urinary incontinence

AIM

To investigate the association between ischemic stroke topography and the onset of urinary incontinence (UI); to evaluate predictors of post-stroke UI in women.

METHOD

We prospectively followed up a cohort of women with ischemic stroke confirmed by clinical and computed tomography (CT) or magnetic resonance imaging (MRI) scans findings. Participants were subjected to interview, clinical evaluation, and urodynamic study if needed at 6 months post-stroke and divided in continent and incontinent groups. Non-parametric tests compared the baseline characteristics among the groups and determined association between post-stroke UI and the brain sites of injury. Logistic regression analysis determined predictors of post-stroke UI. Significance level at 5 % was set.

RESULTS

162 S-women were included: 128 (79 %) continent and 34 (21 %) incontinent. Frontal lobe lesions were higher in the incontinent group (82.9 % versus 51.2 %, p = 0.001); lesions in the parietal lobe and the left cerebral hemisphere were higher in the continent group (40.9 % versus 20 %, p = 0.023; and 61.4 % versus 40 %, p = 0.024, respectively). Frontal lobe injury [RR 3.68 (CI 1.2-11.2)], body mass index (BMI) [RR1.16 (CI 1.062-1.266)] and number of vaginal deliveries [RR 1.358 (CI 1.163-1.585)] are risk factors for post-stroke UI. Left parietal lobe injury is less likely to occur in continent women after 6 months [RR 0.168 (CI 0.029-0.981; p = 0.048)].

CONCLUSION

There is a correlation between the topography of the ischemic stroke and the onset of UI. Frontal lobe lesion, BMI and number of vaginal deliveries are predictors of post-stroke UI.

Association between switching prescribed drugs for lower urinary tract symptoms and independence of urination in post-stroke patients: A retrospective cohort study

OBJECTIVES

Stroke patients frequently exhibit loss of independence of urination, and their lower urinary tract symptoms change with the phase of stroke. However, it is unclear whether switching prescribed drugs for lower urinary tract symptoms during hospitalization from acute care wards to convalescence rehabilitation wards affects patients' independence of urination at discharge. It is also unclear whether the impact of switching varies by stroke type. This retrospective cohort study aimed to examine these issues.

MATERIALS AND METHODS

We analyzed 990 patients registered in the Kaga Regional Cooperation Clinical Pathway for Stroke database during 2015-2019. Prescriptions for lower urinary tract symptoms from pre-onset to convalescence rehabilitation were surveyed. Logistic regression analysis was performed to examine the association between switching drugs and independence of urination based on bladder management and voiding location at discharge. Stroke types were also examined in subgroup analyses.

RESULTS

About 21 % of patients had their lower urinary tract symptoms prescriptions switched during hospitalization. Switching was positively associated with independence of bladder management (odds ratio 1.65, 95 % confidence interval 1.07 to 2.49) and voiding location (odds ratio 2.72, 95 % confidence interval 1.72 to 4.37). Similar associations were observed in different stroke types.

CONCLUSIONS

Approximately 20 % of patients had their lower urinary tract symptoms medications switched upon transfer from acute to convalescence rehabilitation wards. Switching was significantly associated with improved urinary independence at discharge. Consistent results were observed across different stroke types, suggesting that switching medications contributes to urinary independence after stroke, regardless of the etiology or severity of stroke.

Relation between Lower Urinary Tract Dysfunction and Functional Outcome in Patients After Brain Tumor Resection

This study aimed to compare functional outcomes after rehabilitation with initial degree of urinary retention (UR) in patients operated on for brain tumors. Medical records of 61 patients transferred to the Department of Rehabilitation Medicine of single center, from January 2011 to December 2021, were reviewed retrospectively. Patient data included post-void residual (PVR) urine, tumor characteristics, and functional status. Functional status was evaluated on the Mini-Mental Status Examination (MMSE), Modified Barthel Index (MBI), Functional Ambulation Category (FAC), Modified Rankin Scale (mRS), Motricity Index (MI)-lower limb, and Berg Balance Scale (BBS). MMSE, FAC, mRS, and MI-lower limb were re-evaluated 3 weeks after standard inpatient rehabilitation. Twenty-four patients were in the UR group and 37 in the non-UR group. Initial MMSE, MBI, BBS, FAC, and mRS were significantly worse in the UR group, and both groups showed significant functional improvement after rehabilitation. After rehabilitation, MMSE, FAC, MRS, MI-lower were still worse in the UR group, but the degree of improvement between the groups was not significantly different. Rehabilitation was shown to be effective for brain tumor patients regardless of UR. Initial UR after brain tumor surgery is significantly associated with poor functional status in both the early stages of rehabilitation and after rehabilitation.

The investigation of cognition, proprioception, sensory and physical function in stroke patients with urinary incontinence

PURPOSE

This study aimed to investigate cognition, proprioception, and sensory/physical function in stroke patients with urinary incontinence (UI).

METHODS

A prospective cross-sectional study was conducted on 53 individuals with stroke (23 had UI and 21 matched controls). The Incontinence Impact Questionnaire Short Form (IIQ-7) and Urogenital Distress Inventory (UDI-6) were used to assess the patients' UI symptoms. Participants were also evaluated with Mini-Mental State Examination (MMSE), Barthel Index (BI), Fugl-Meyer Sensory Assessment (FMA-S), Five Times Sit to Stand Test (FTSST), Functional Reach Test (FRT) and Proprioception Test.

RESULTS

FTSST, FRT and FMA-S were better in stroke subjects without UI (p < 0.05). There was a moderate correlation between IIQ-7 with FMA-S, FTSST and proprioception (left extremity) (r₁: - 0.415, r₂: 0.440, r₃: 0.430, p < 0.05) and a low correlation with BI (r: - 0.356, p < 0.05).

CONCLUSION

Individuals with UI had worse sensory/motor function and static balance. Stroke patients with UI were more dependent, had less sensory function, and had worse lower extremity muscle strength and proprioception as the level of urinary incontinence increased. To reduce urinary incontinence, emphasis on motor/sensory function, balance, and proprioception should be considered.

Promoting urinary continence in people suffering a stroke: Effectiveness of a complex intervention-An intervention study

Aim

The study aimed to implement and measure effectiveness of a systematic continence management intervention in people suffering a stroke in undertaking rehabilitation.

Design

An intervention study was conducted.

Methods

In the first part of the study, patients were included in the control group and observed. After the training of the nursing staff, participants were assigned to the intervention group. The intervention consisted of screening, assessment, treatment, communication and evaluation.

Results

Forty‐six patients took part in the study, of which 35 were in the control and 11 in the intervention groups. Within the two groups, significant improvements in outcomes were mostly seen during the study. For the Incontinence Quality of Life Social Embarrassment scale, a significantly higher increase was observed for the intervention group. The improvement between admission and discharge in the intervention group was notably larger for the outcome's incontinence and quality of life.

The Relationship Between Urinary Symptom Severity And Functional Status İn Patients With Stroke

BACKGROUND

Lower Urinary Tract Dysfunction (LUTD) is a condition that is common in stroke patients and affects their quality of life and psychological state.

AIM

To determine the factors affecting LUTD severity in stroke patients and to evaluate its relationship with functional status.

METHOD

77 stroke patients were included in our study. Demographic and stroke characteristics of all patients were recorded. Functional Ambulation Scale (FAS), Functional Independence Measure (FIM), the Core Lower Urinary Tract Symptom Score (CLSS) Questionnaire, Beck Depression Scale were administered to the patient. 33 of 77 patients had urodynamic study and these patients constituted the subgroup of the study. Patients were grouped according to type of disorder, type of detrusor and detrusor sphincter dyssynergia (DSD) using urodynamic study findings.

RESULT

The mean CLSS of men was significantly higher than women (P = 0.017). A significant positive correlation was found between age and CLSS (P = 0.035 r = 0.24) and negative correlation was found between total FIM and all sub-parameter scores and mean of CLSS (P = 0.001 r = -0.467).

CONCLUSION

LUTD is common in stroke patients and the presence of urinary symptoms is associated with poor functional status. No significant relationship was observed between urodynamic data except maximum flow rate and CLSS.

Nocturia in patients with cognitive dysfunction: a systematic review of the literature

Background

The objective of this study is to evaluate current literature on the association between cognitive dysfunction and nocturia.

Methods

A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted through MEDLINE, EMBASE and COCHRANE databases and completed in November 2019. Randomized and non-randomized studies were included if they assessed the association between cognitive dysfunction and nocturia in older participants with or without neurological diseases. The quality of included studies was evaluated using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS).

Results

A total of 8 cross-sectional studies conducted in older patient populations met the criteria for inclusion. A statistically significant association was identified in 6 studies on univariate analysis, which persisted in 2 studies after controlling for confounding factors. The association between cognitive dysfunction and nocturia was positive for all 6 significant analyses. The overall risk of bias was unclear.

Conclusion

A significant positive association between cognitive dysfunction and nocturia was identified. However, research has been limited to cross-sectional studies, which precludes identification of causality between cognitive dysfunction and nocturia. Heightened awareness of the complex interplay between cognition and nocturia would allow professionals involved in the care of cognitively impaired patients with concomitant nocturia to more effectively manage these symptoms.

Nocturia and Nocturnal Polyuria in Neurological Patients: From Epidemiology to Treatment. A Systematic Review of the Literature

CONTEXT

Nocturia is among the most common and bothersome lower urinary tract symptoms (LUTS), but there is no clear consensus on how to identify and manage this symptom in the neurological population.

OBJECTIVE

To systematically review the literature about nocturia in neurological patients.

EVIDENCE ACQUISITION

Studies were identified by electronic search of Cochrane and Medline databases. The studies were included if their participants had acquired neurological pathology among multiple sclerosis (MS), Parkinson's disease (PD), stroke, spinal cord injury (SCI), and reported data on the epidemiology, aetiology, diagnosis, or treatment of nocturia. An independent extraction of the articles was performed by two authors using predetermined datasets, including quality-of-study indicators.

EVIDENCE SYNTHESIS

A total of 132 studies were included; 46 evaluated the epidemiology of nocturia, 28 the possible aetiologies, 10 the diagnostic tools, and 60 the treatments. Nocturia prevalence ranged from 15% to 96% depending on the pathology and definition used. It was one of the most frequently reported LUTS in PD and stroke patients. Several validated questionnaires were found to screen for nocturia in this population. Causalities were numerous: LUT, renal, sleep, cardiovascular dysfunctions, etc. Treatments targeted these mechanisms, with an overall risk of bias assessed as high or serious. The highest level of evidence was seen in MS patients: pelvic floor muscle training, cannabinoids, and desmopressin were effective, but not melatonin. In stroke patients, transcutaneous sacral and transcutaneous tibial nerve stimulation (TTNS) improved nocturia; in PD patients, TTNS, solifenacin, and rotigotine did not.

CONCLUSIONS

Nocturia is highly prevalent in patients with neurological disorders. Causalities and treatments are not different from the general population, but are poorly studied in neurological patients.

PATIENT SUMMARY

In this report, we looked at the published studies about nocturia-the fact of waking to void during the hours of sleep-in patients with neurological diseases. We found that nocturia is very frequent in this population, that the causes are the same as in the general population but may be combined, and that treatments are also the same but have an overall weak level of evidence. We conclude that more research is needed on this topic.